Purpose: To compare efficiency and safety of epithelium-off corneal cross-linking (CXL) and transepithelial cross-linking (TE-CXL) in pediatric patients with progressive keratoconus.
Methods: Uncorrected and corrected visual acuity, corneal topography and pachymetry (Pentacam; Oculus Pentacam), and in vivo confocal microscopy (HRT II, Rostock Cornea Module, Heidelberg Engineering, Heidelberg, Germany) were evaluated at baseline and at 3, 6, and 12 months.
Results: In the epithelium-off CXL group (19 patients, 23 eyes; mean age, 14.75 ± 2.1 years), a significant improvement at month 12 was present for Kmax [−1.11 diopters (D), P = 0.01], Kmin (−3.2 D, P = 0.001), mean K (−1.47 D, P = 0.01), surface asymmetry index (−0.64 D, P = 0.001), inferior–superior symmetry index (−0.54 D, P = 0.01), index of height asymmetry (−2.97, P = 0.03), and anterior elevation at the thinnest location (−2.82 D, P = 0.01) and at the apex (−2.27 D, P = 0.01). Postoperative corneal edema lasted 3 months in 16 eyes (69.5%) and more than 6 months in 2 eyes (8.7%). In the TE-CXL group (10 patients, 14 eyes; mean age, 15 ± 4.2 years), a significant improvement at month 12 was present for Kmax (−1.14 D, P = 0.02), Kmin (−2.04 D, P = 0.01), mean K (−1.63 D, P = 0.01), surface asymmetry index (−0.86 D, P = 0.001), inferior–superior symmetry index (−0.55 D, P = 0.001), index of height asymmetry (−2.95, P = 0.01), and anterior elevation at the thinnest location (−2.96 D, P = 0.01) and at the apex (−2.19 D, P = 0.01). No postoperative corneal edema after TE-CXL was observed. Changes at month 12 from baseline were not significantly different between the 2 groups (P > 0.05). TE-CXE was significantly less painful than epithelium-off CXL.
Conclusions: In pediatric patients with progressive keratoconus, TE-CXL was less painful, provided similar effectiveness and fewer complications than epithelium-off CXL at 12-month follow-up.
*Eye Department, University Federico II, Naples, Italy
†Eye Department, Pellegrini Hospital, Naples, Italy
‡Eye Department, Niguarda Hospital, Milan, Italy. Dr. Magli is currently affiliated with the Pediatric Ophthalmology Department, University of Salerno, Italy.
Reprints: Raimondo Forte Dipartimento di Scienze Oftalmologiche, Università Federico II, Via Pansini 5, 80131 Naples, Italy (e-mail: firstname.lastname@example.org).
The authors have no conflicts of interest to disclose.
The study was performed with informed consent and following all the guidelines for experimental investigations required by the Institutional Review Board or Ethics Committee of which all authors are affiliated.
Received June 15, 2012
Accepted August 1, 2012